With the alarm blaring at 6:30 am, I awoke to the sun rising on a Monday morning. However, this was no ordinary Monday; I wasn’t getting ready to go to school, but rather was preparing for my first day of a weeklong service trip in Jamaica. Within the hour, I quickly got changed, packed my camera, and ran by the hotel cafeteria to get a bite to eat to sustain me for the long day ahead. Finally reaching the bus, I was greeted by the other students and faculty that had made the trip from their homes to volunteer their time and service to the local population. With excitement and a hint of nervousness in the air, we all departed the hotel for a two-hour ride to our first location.

As the driver navigated the dangerous, narrow, and winding roads for the last thirty minutes of the drive, it seemed like an eternity before he told us that we would be at our destination in less than a mile. As I looked out the window, I noticed a few villagers walking in the same direction as the bus was driving. As we got closer to the site, I noticed a larger crowd of people, again walking in the same direction. When we finally reached the church in the town of Clermont, the bus was greeted with all of the local residents awaiting the basic dental care that they experience only through these volunteer events. As my fellow classmates and I were second years, we were to work with the dental hygienists with basic scaling and prophy treatment. With the line for treatment wrapping outside of the church, we worked diligently with the mindset of leaving no patient without treatment.

One patient that particularly stood out to me during the endless day was a teenage boy that came for a fluoride varnish. Upon examination, I had noticed rampant caries that had affected most of his lower teeth and swelling that according to my academic training indicated extraction. After telling him that he should go to the extraction side of the dental operation to get a consult, tears immediately began to form in his eyes. Seeing his tears, it made me step back and realize that even though according to my knowledge the procedure would be quite simple, to the teenage boy it was a procedure that seemed so foreign and horrifying. Scared, he asked me if I could go with him, a request that I happily agreed to.

Upon meeting the oral surgeon, anesthesia was given and he was set up to get six extractions. It was at this moment that he told me how much pain those teeth had been causing him and that he would do anything to get out of pain. When I asked him why he didn’t get any treatment previously, he indicated that his family had no access to dental care. At this particular moment, I realized for the first time on the trip not only how badly the local population needed dental care and education, but also how much they wanted it.

Holding his hand throughout the extractions, his determination in getting out of chronic pain far outweighed his vast fear; this was clear by the almost complete blanching of my hand due to the immense amount of force he was squeezing it with. After the three minutes that seemed like an eternity for him, he was told to bite down on the gauze that was placed in his mouth, indicating he was all done. As he sat up, I was once again greeted by tears. However this time, it was a very different kind of tears: tears of joy. Knowing that he would no longer be in the amount of pain he had been in, he happily thanked me and excitedly began his four-mile walk home with his father.

As the week passed, there were countless moments that continued to strengthen my desire for service work. Aside from my love for dentistry, these moments really helped remind me no matter how minor or insignificant a procedure may seem to somebody, it could drastically change the quality of life for another. It was during these moments that I also realized global outreach is something that doesn’t end with a week or even a month long period of service, but it is an effort to build continued, sustainable care. Although the individuals in Jamaica were so thankful for our service, I will forever be indebted to them for the lessons and memories I hold close to my heart today.

It’s Work Day 1 of the trip, and after a two hour bus ride to a church in a rural town called Clermont, we arrive at our work site. We get off of the bus and chaos ensues as children and adults alike greet us, anxious to get inside for care. We scatter, converting folding tables into surgical stations and hygiene bays. The second year dental students man the hygiene station, excited to see our first patients that aren’t our classmates. The morning flies by. After a blur of cleanings one after another – scaling-prophy-fluoride, scaling-prophy-fluoride – I am called over to do my first local anesthesia injection since our certification workshop in class two weeks earlier.

An instructor presents the case to me: 22 year old female presenting for extraction of tooth numbers 8, 9 12, and 13. Patient plans to visit local dentist post-extraction to receive a removable partial denture. I look at her, but only quickly as I try to mask my nerves. I run through my steps in my head as I move: infiltrate using 2 carpules of 2% Lidocaine with epinephrine 1:100,000 for maxillary right and left central incisor, left first premolar, and left second premolar. Remember my anatomy. Dry the area, apply topical, load my syringe, check my path of insertion, make sure I’m parallel to the long axis of the tooth, don’t forget my finger rest, insert the needle, always aspirate, go ahead and inject. Now the palatal, check for blanching, repeat on the next tooth, recap the needle, be careful of a needlestick. Breathe. I review my process in my head, and I am pleased with my technical execution of one of my first ever injections.

Then, for the first time, I really look at my patient. I was too nervous beforehand to acknowledge the fact that she was probably immensely more nervous than I was for what was about to happen. So I looked at my situation again; this 22 year old girl, le was just two years younger than I was, came to our clinic asking for us to remove four of her teeth, two of which were her “two front teeth,” because they were causing her so much pain. She was 22 years old, too young to be losing these critical teeth. She said that she had plans to visit a dentist and to get a partial denture, but a nagging voice in the back of my mind wondered if she would actually have the chance to follow up on this, if she would have access to a local dentist who could prevent her from living without two of her most aesthetically significant teeth for the rest of her life. I got so caught up in the fact that I was doing an injection on a real live patient that I didn’t even take a second to think about the teeth that I was anesthetizing for extraction on this beautiful, articulate, and otherwise healthy young woman. Immediately, I was overwhelmingly disappointed in myself for getting lost in the technical aspect of this woman’s care and failing to see the person behind the procedure.

After that moment, I finally saw my patient not just as someone who could help me hone some new dental skill, but as someone who could teach me so much more than that; I saw her as someone who could bring to light for me the discrepancy between dental care in places like rural Jamaica compared to certain areas of the U.S. I saw her as someone in a situation that would probably never happen in my hometown in New York. This is when it really hit home for me that participating in global outreach and showing up for just one week is not enough. Our work is not done after only one visit to a country. This has to be a continued effort that focuses not only on treatment of symptoms, but on prevention of the problems that cause these symptoms in the first place, and on education about how to do so. This way, the next time we see this 22 year old woman, she will be coming in for a regular cleaning rather than to have four more teeth extracted.

I now know that one of the most essential things I learned in Jamaica was not the best angle to approach an IAN block from, or what a Cowhorn is, or how much pressure to use to pop a stubborn chunk of calculus off of a tooth. The most important thing that I learned had nothing to do with the technical skills of dentistry. Rather, I learned how to be both a provider of care and an empathetic person at the same time, how to integrate both scientific and interpersonal skills into one experience for my patients. As second years, every single bit of this trip was almost brand new to us. We were sponges trying to absorb as much information as we possibly could. However, I realized the importance of stepping back to acknowledge that I was no longer working on a typodont or on the person who sat next to me in class for the last two years. I was working on children who had never been to the dentist before, or on grown men who were more anxious than their children to be sitting in that folding chair. Learning how to speak to these people in a professional manner, but also in a way that would comfort them in the midst of the fast paced, hectic buzz that is the atmosphere in one of these improvised clinics where 300 to 400 patients shuffle through each day was one of the hardest things I’ve had to do. It’s certainly not something I could have learned in class, no matter how many times I read about it in a book.

I admit that after being immersed in an entirely patient-based setting, it was difficult to return to Tufts and jump right back into the 10 PM nights in preclin followed by 2 AM nights of studying before exam blocks. In the same way that in Jamaica I neglected to see my patient past the needle of my syringe, I now sometimes forget to look past every seemingly impossible project or every grueling exam block to see the big picture: that we are working so hard now to be able to give our patients the best care that we can, whether at home or abroad. So in this way, the perspective I learned in Jamaica has come back with me, even though we are not yet in the clinic seeing patients.

One of the most profound things that a professor said to our class is that it is not in every profession that you can put your hands on someone and take away their pain. I don’t think I really grasped just how much that meant before we went to Jamaica. Seeing people come to us in pain, go through a foreign and frightening procedure, and yet leave happy as can be because we got rid of their pain was one of the most gratifying experiences I have ever been a part of, and I could not be more excited to spend the rest of my life doing just that.

-Kelly Barbera

Michael Golub (D18) Reflects on his Service Learning Trip to Jamaica – February 2016

“Last month I had the opportunity to travel to Jamaica for the second time on a dental outreach program. My first trip was five years ago, while a pre-dental student in college. Returning to Jamaica, this year, I was once again charmed by the Jamaican people, and their “no problem” attitude. The outreach was incredible. It was a real life experience that brought together aspects of basic sciences, clinical expertise and global outreach. It was not uncommon to have an adult patient who was diabetic or had high blood pressure; thus, we utilized our medical team and our understanding of medical issues to clear these patients for treatment. Our background in global outreach and knowledge from the GSL course helped us understand the culture, while our skills in providing anesthesia and hygiene were put to the test.

Each day we travelled to new sites deep in the mountains of Jamaica. Most of the bus rides were between 2 and 3 hours. This allowed the team to come up with a plan on the way there and conversely, reflect and share stories on the way back to our hotel. Two of the days we set up our clinics in churches. These communities were known as feeder communities, to which people walked up to 30 miles to be seen. The majority of those patients were adults. The other sites that we visited were elementary schools where we saw all of the children attending those schools along with the adults in the community. Most of these areas were farming towns where the local people grew sugar cane, coffee and different spices. Interestingly, in these rural areas, it was not poverty that provided a barrier to healthcare, but rather, they just had no access to medical or dental care. I spoke to several townspeople who told me that if anyone had a toothache in their town they would pull the tooth themselves. Having heard that, I knew that our efforts were going to be appreciated.

The lack of language barrier allowed us to interact and relate to our patients. I was able to talk to them about their lives, their daily routines, and their oral healthcare knowledge. As a second year student, a lot of my responsibility included cleanings and oral health promotion. I saw extreme periodontitis that exceeded the extreme examples we had been shown in class. There were walls of calculus which provided the only attachment to compromised teeth. In our makeshift hygiene clinic, we did whatever we could to remove as much calculus and plaque as possible. Most of these patients had never seen dental floss. We were able to show them how to use floss and send each patient home with their own pack. I found it very interesting to see how much they loved the Listerine mouthwash. As much as the children loved the stickers and bracelets that we gave out, the adults LOVED the mouthwash.

Dentistry is a special profession in which we are able to promote health, relieve pain, educate and restore people’s quality of life. And that’s why Global Outreach is so very special. We are able to provide this valuable care to people who otherwise would be neglected. On my first trip to Jamaica, a young boy told me that he hoped to become a dentist. I looked for this guy everywhere we went. Though I couldn’t find him, I hope he continues to pursue this dream. As much as we are uplifted by our volunteer work in Jamaica, nothing would make me happier than seeing the local people receive regular sustainable health care.”

TUSDM students are going to Jamaica! – November 2015

In January 2016, the Tufts Global Outreach program will be visiting Jamaica for the very first time! Michael Golub (D18) first visited Jamaica in 2011 as a volunteer with Healthcare International. This year three additional students (Tahira Williams D16, Kelly Barbera D18, Tim Kim D18) will be joining him along with students from Michigan dental school and faculty from the dental school at NYU. Healthcare International is an organization made up of dentists and physicians whose goal is to provide dental and medical care for patients in the rural areas of Jamaica who have little or no access to health care. The Tufts team will be providing dental extractions, cleanings, fillings as well as offering a full range of preventative care including: oral health education, free toothbrushes and toothpaste. This trip will offer the Tufts students a unique clinical experience as well as allow TUSDM to partner with an organization that has a strong proven record or providing essential care to an underserved population in Jamaica.

A native from Jamaica, Tahira Williams (D16) states “I decided to participate firstly because it was an opportunity to go home and give back to a community that has limited access to dental care and secondly it would be a good learning experience outside of the United States.”

Help the students reach their fundraising goal by donating at the link below:

Building student involvement, fostering civic engagement and enhancing community service to advance public health.

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